Provider Demographics
NPI:1689060121
Name:GRAYSON, MAE (CLC)
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 DENISON DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7516
Mailing Address - Country:US
Mailing Address - Phone:405-250-9279
Mailing Address - Fax:405-360-9893
Practice Address - Street 1:816 DENISON DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7516
Practice Address - Country:US
Practice Address - Phone:405-250-9279
Practice Address - Fax:405-360-9893
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty